Implementation in action
4. Stage 1: Engage and explore
An implementation process begins with an exploration of your current practices and context, and a consideration of what needs to change to improve outcomes for children and families. During this stage, you also identify potential solutions to bring about your desired changes.
During this stage, your aim is to make an informed decision about which evidence-informed program or practice to adopt. You also need to assess your organisation's readiness to implement this program or practice. As you move through this process, engage as many internal stakeholders as possible. Consider running workshops or other collaborative activities to explore their insights and understand their preferences and experiences.
To make good decisions about what program or practice to implement, you need to consider:
- the needs of the target population participating in your service
- the outcomes you'd like to achieve with and for children and families
- your agency or service provider's capacity to implement the new program or practice
- the evidence proving the effectiveness of the program or practice you plan to implement.
4.1 Define what needs to change and for whom
Before you select your new program or practice, identify your target population and assess their needs. Focus on the needs that are not being met by existing services. To avoid duplicating services within a region, identify the needs not currently being met by any service - not just your own. A service-mapping exercise can aid in this process. This exercise requires you to systematically review the service providers in your area and describe what they offer your target population.
To assess the needs of the target population, use data that indicate the intensity of the problem. Involve all relevant stakeholders who can help find solutions, including people from other service providers in your region. This exercise helps to identify and define the problem you're trying to solve with your new initiative.
Next, identify the outcomes you'd like the new initiative to bring about for children and families. These should be measurable changes or benefits that are experienced as a result of your new program or practice. The outcomes should relate to the problem you defined at the start of this step. For example, if the problem was defined as children living in an unsafe home environment, relevant outcomes might include a decrease in child injuries and adequate stimulation for children in the home environment. This process helps you to narrow down the possible programs or practices under consideration. Using a program logic can help, as it draws out the relationships between program or practice inputs (e.g. resources), outputs (e.g. key activities) and outcomes (e.g. benefits for children and families). Refer to the Child Family Community Australia guidance for developing a program logic for more information.
Box 1 provides example questions that you can use when defining your target population, their needs and the desired outcomes.
Using an outcomes framework can help you identify and describe which outcomes you'd like to create. Examples include the NSW Government Human Services Outcomes Framework and the Victorian Public Health and Wellbeing Outcomes Framework.
4.2 Select and adopt an evidence-informed program or practice
Your next step is to identify existing programs or practices that have been proven to effectively address your problem and bring about the desired outcome. Consider where you might find these programs or practices. There are several menus and repositories of evidence-informed programs and practices,and these can help you identify available interventions. The program or practice also needs to be:
- a good fit for your context. Ideally, it has been shown to work for your target population, in a similar setting.
- feasible. Your agency or service provider is able to obtain the necessary resources (e.g. funding, staff, meeting rooms, vehicles) and capacity (e.g. relevant expertise, referral sources) to implement the program or practice.
You can use the Implementation Considerations Checklist tool (Appendix C) to guide decision makers through the selection and adoption process.
The Implementation Considerations Checklist tool (Appendix C) can help you select a program that's appropriate and feasible for your context.
4.3 Set up an implementation team
Your implementation team will champion and drive your implementation process. It's an internal team and its purpose is to move the new program or practice through the implementation stages. It also solves problems that arise due to implementation barriers. Establishing well-informed and collaborative implementation teams (sometimes referred to as 'coalitions') can help your organisation to commit to high-quality implementation of programs and practices (Brown, Feinberg, & Greenberg, 2010).
Should I establish an implementation team?
It isn't always feasible or desirable to establish an implementation team. This may be due to staffing limitations, time restrictions, and external or executive decisions. However, implementation teams may be useful in these circumstances:
- Where the new program or practice is complex or is a significant shift away from current practice.
- Where the implementation of the program or practice impacts staff from different parts of the organisation (or across multiple sites).
- Where it's unclear who's responsible for implementing the program or practice.
Table 2 presents an overview of the implementation team's purpose, composition and core capabilities.
Over time, the work of the team will be refined. The tasks and composition of the team can change as the implementation stages progress. Be prepared to change the membership of the implementation team over time, as needed. Consider:
- What core competencies are needed to drive the implementation at each implementation stage?
- Who has the skills, knowledge and decision-making authority to effectively facilitate the necessary implementation activities?
- Which internal stakeholders need to be included?
- What organisational systems and policies are needed to support implementation?
When you're establishing your implementation team, it's essential to invest time in the initial implementation team planning. You'll need to:
- select team members
- ensure the team has the appropriate authority to implement changes and make decisions 'in the room' to improve implementation
- develop accountability mechanisms, including tracking actions and scheduling regular meetings.
4.4 Consider likely enablers and barriers, and assess readiness
Explore possible enablers and barriers
Early in the process, it's helpful to consider likely enablers and barriers to implementation. You can start doing this when you're familiar with the program or practice you want to implement.
You should continue to monitor enablers and barriers throughout the implementation process, as different opportunities and challenges are likely to emerge as the process unfolds. However, starting now will help you identify and address early barriers that could slow down the process and reduce momentum. It will also help you to nurture the enablers which will help the new program or practice to flourish.
Some enablers and barriers will be obvious. For example, you may have a clear mandate from senior leadership to use whatever resources it takes to initiate your new program. Or, conversely, you might not have enough funding to support the program you've selected. Or, practitioners may need to be upskilled in the new practice you are seeking to implement. Other enablers and barriers will be less obvious, though no less important.
You may find it helpful to take a structured approach when assessing enablers and barriers. This approach can guide your thinking and help you to clearly see the obstacles to overcome and the existing enablers to be maintained. One common approach for exploring enablers and barriers is the Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., 2009).
The CFIR identifies five domains that will influence your implementation process:
- characteristics of the program or practice itself (e.g. adaptability and cost)
- individuals involved in implementation (e.g. knowledge and beliefs about the program or practice)
- the inner context or setting (e.g. organisational culture and leadership engagement)
- the outer context or setting (e.g. client needs, and policy and funding priorities)
- the implementation process (e.g. planning, reflecting and evaluating).
The CFIR website describes the factors that influence implementation within each domain. It also contains tools for identifying the specific enablers and barriers in each domain.
You can use the CFIR Interview Guide Tool to build a set of questions to guide your discussions. These can also help you to assess the enablers and barriers that are most important in your setting. The questions can be used for interviews with staff and they can guide the implementation team's discussions, as well as discussions with other decision makers during the implementation process.
Assess organisational readiness
Organisational readiness is an important aspect of your implementation. It is a key potential barrier (or enabler) to consider at this early stage of implementation. It will help you know where to focus your efforts in the next stage.
Organisational readiness refers to the extent to which your organisation is willing and able to implement the selected program or practice (Scaccia et al., 2015). Low organisational readiness is a common barrier at this stage of implementation. However, it's important to understand that 'readiness' is not a static condition. Your organisation does not have to be 100% 'ready' at the very beginning of the implementation process. Some aspects of readiness may not be present at first, but you can use implementation strategies to build them later. Readiness may also decrease over time; for example, if key staff leave your organisation. You can reassess your level of readiness at particular points during the implementation process and this can further inform your decisions on what support or change is needed. For example, the very end of Stage 2 is a good time to reassess readiness to check if the organisation is ready to initiate the practice.
A framework or tool can be useful to help to guide your assessment of organisational readiness. The Readiness = Motivation x Capacity (General) x Capacity (Specific) framework (or R=MC2; Scaccia et al., 2015) describes three factors that influence organisational readiness for implementation:
- the motivation of agency or service provider staff to implement the program or practice
- the general capacities of an agency or service provider
- the program- and practice-specific capacities needed to implement the intervention.
You can assess these three components using the Wandersman Center’s Readiness Thinking Tool® (see Appendix D). This tool helps you to consider whether the different components are strengths or challenges for your organisation. The tool also provides suggested discussion questions to help you respond to your readiness assessment findings. The goal of this process is to identify how you can improve organisational readiness and enhance the likelihood of implementation success.
2 Several such menus exist; for example, Communities for Children Facilitating Partners Evidence-based Programme Profiles ( apps.aifs.gov.au/cfca/guidebook/), the Early Intervention Foundation Guidebook ( guidebook.eif.org.uk/), and the California Evidence-Based Clearinghouse for Child Welfare (www.cebc4cw.org/)